Pandazi Ageliki, Bourlioti Anastasia, Kostopanagiotou Georgia
2nd Department of Anesthesiology, University of Athens School of Medicine, Attikon Hospital, Athens, Greece.
Obes Surg. 2005 Jan;15(1):58-62. doi: 10.1381/0960892052993585.
Early and uneventful postoperative recovery of morbidly obese patients remains a challenge for anesthesiologists. BIS monitoring is useful in providing fast recovery.
We describe the anesthetic management of 23 morbidly obese patients who underwent elective open Roux-en-Y gastric bypass (RYGBP) for morbid obesity. Thoracic epidural analgesia combined with light general anesthesia with propofol and nitrous oxide adjusted to keep the bispectral index (BIS) around 60 was performed. Intraoperative hemodynamic stability, early and intermediate recovery and patient satisfaction were assessed.
The cardiovascular variables were fairly stable during surgery. Times to spontaneous respiration, response to orders, tube removal and orientation were 4 +/- 3, 6 +/- 2, 8 +/-3, and 13 +/- 7 respectively. Times until the patients were able to sit unassisted, stand unassisted and walk freely without assistance were 319 +/- 25, 803 +/- 78, 1070 +/- 75 respectively (values expressed as min, mean +/- se).
Propofol-nitrous oxide anesthesia adjusted to keep BIS around 60, combined with thoracic epidural analgesia, seems to be effective in providing predictable and uneventful recovery to patients submitted to elective RYGBP.
病态肥胖患者术后早期平稳恢复对麻醉医生而言仍是一项挑战。脑电双频指数（BIS）监测有助于实现快速恢复。
我们描述了23例因病态肥胖接受择期开放性 Roux-en-Y 胃旁路术（RYGBP）的病态肥胖患者的麻醉管理。采用胸段硬膜外镇痛联合丙泊酚和氧化亚氮的浅全身麻醉，并调整麻醉深度使脑电双频指数（BIS）维持在60左右。评估术中血流动力学稳定性、早期及中期恢复情况和患者满意度。
手术过程中心血管变量相当稳定。自主呼吸恢复时间、对指令的反应时间、拔管时间和定向时间分别为4±3、6±2、8±3和13±7分钟。患者能够独立坐起、独立站立和独立自由行走的时间分别为319±25、803±78、1070±75分钟（数值以分钟表示，均值±标准误）。
调整丙泊酚-氧化亚氮麻醉使BIS维持在60左右，联合胸段硬膜外镇痛，似乎能有效为接受择期RYGBP手术的患者提供可预测的平稳恢复。
